Meeting Notes

Participants

Co-Chairs:

Jean-Bernard Parenteau, Global Affairs Canada; Dr Patrick Kuma-Aboagye, Ministry of Health, Ghana.

Participants:

Kristen Chenier, Ayah Nayfeh, Global Affairs Canada; Dr Polydor Mbongani Kabila, Democratic Republic of the Congo; Dr Ruth Nigatu, Ministry of Health, Ethiopia; Jolin-Sophie Krebs, BMZ, Germany;  Lynda Wardhani, Ministry of Foreign Affairs, Indonesia; Eugenia Palagi, Federica Polselli, Ministry of Foreign Affairs and International Cooperation, Italy; Gerald Manthalu, Ministry of Health, Malawi; Hannah Haaij, Ministry of Foreign Affairs, Netherlands; Dr Kristine Husøy Ornaheim, Ministry of Foreign Affairs, Paul Fife, NORAD, Norway;  Magnus Lennartsson, Ministry of Foreign Affairs, Sweden; Samrita Sidhu, Anna Seymour, FCDO, United Kingdom; Dr Atul Gawande, USAID; Faith Nfii, Africa CDC; Susan Mochache, African Constituency Bureau of the Global Fund;  Birgitte Hagelund, Grégoire Lacoin, DG International Partnerships, the European Commission; Katy Kydd Wright, Global Fund Advocates Network;  Magda Robalo, Institute for Global Health and Development, Guinea-Bissau;  Lori Sloate, United Nations Foundation; Beck Smith, Clare Battle, Wellcome.

Secretariat: Linda Muller.

Co-chair update and anchoring the Lusaka Agenda on global health initiative (GHI) boards:

Lusaka Agenda Working Group (LAWG) Co-Chair Jean-Bernard Parenteau paid tribute to the engagement and contribution of Working Group members in helping to strengthen collaboration across the global health ecosystem and in advancing the LAWG’s objectives:

  1. Anchoring the Lusaka Agenda on the agenda of GHI boards and the African Union (AU), and beginning to drive its implementation;
  2. Engaging with key stakeholders, including civil society, and a broader group of donor and implementing countries to design arrangements for ongoing collaboration to advance the Lusaka Agenda conclusions.

While acknowledging that the process has not always been seamless and that additional attention to the engagement of civil society and communities is required, the Co-Chair noted the positive momentum across GHIs and other partners. The 4 April joint letter to GHI board leadership signed by 16 Gavi/Global Fund/Global Financing Facility board members/constituencies calling for a joint committee working group to drive forward joint work, has been shared with all Gavi and Global Fund board members. Global Fund board leadership wrote welcoming the letter.

Of note, discussions on the Lusaka Agenda and the need for a joint committee working group were advanced in recent GHI committee meetings, on the 8 April informal joint Gavi/Global Fund joint board call on malaria, and during a 9 April Global Fund donor group meeting. Several implementing country board representatives were vocal in their calls for better coordination between GHIs.

It was noted that the joint working group, while initially focusing on joint GHI workstreams, can be a springboard to other elements of the Lusaka Agenda. It was further emphasized that clarity is required on the timeline for the establishment of the joint working group, its composition and terms of reference and that continued advocacy, including at the upcoming Gavi Governance Committee Meeting and Gavi and Global Fund board retreats and Global Fund board meeting, would be important.

Several Working Group members noted actions also by other global and regional health actors to anchor the Lusaka Agenda key shifts and principles in their work. The important role of WHO in enabling Lusaka Agenda implementation was underscored and the work of partners on the African continent in supporting in-country operationalization of the Lusaka Agenda was highlighted as an area of paramount importance.

While the LAWG was established as an interim (January – April 2024) mechanism, there was consensus that its work is not complete. There was broad support for the proposal for a single extension of the Working Group and its part-time Secretariat until end-June, with the same objectives. Meeting participants suggested the following indicators of success:

  • being able to hand over to the joint committee working group so the Lusaka Agenda is embedded in GHI board accountability;
  • being confident in the progress on pathfinder country identification and that GHIs are committed to working at scale to implement the Lusaka Agenda conclusions (ie not only in pathfinder countries);
  • seeing a shift in the centre of gravity towards African countries and institutions.

LAWG members also noted the importance of CSO engagement and highlighted that that long-term success will be measured in systems change and the embedding of the Lusaka Agenda principles in the work of other actors.

With regards to objective two, it was proposed that success could be defined as the LAWG aligning on the roadmap to consider arrangements for ongoing collaboration to advance the Lusaka Agenda conclusions within the broader global health financing architecture (see meeting slides for two possible scenarios). Several meeting participants underscored the importance of setting a high ambition and driving for systemic change.

In follow up to this discussion, the Co-Chairs and Secretariat will further iterate the success indicators and share with the LAWG ahead of the next meeting.

To enable the LAWG extension until end-June, Canada is working to secure bridge funding to support activities, including support to the part-time Lusaka Agenda Secretariat, over the coming months.

There was an offer by the Global Fund Advocates Network to work with the LAWG Co-Chairs and Secretariat to map out a plan for civil society engagement going forward, noting that this engagement might not necessarily be under a Lusaka Agenda banner.

Catalyzing change in Africa:

An African Constituency Bureau for the Global Fund (ACB) update on work by regional institutions to drive forward Lusaka Agenda implementation in countries on the continent was warmly welcomed. Even pending the publication of the decisions from the February AU Summit, including its endorsement of AU PPPR Champion South African President Ramaphosa’s recommendation to “support the establishment of an accountability mechanism within the AU architecture to ensure effective implementation of the Lusaka Agenda in Africa”, African institutions are following up to be prepared to implement a framework to enhance coordinated efforts and accountability in the region.

For example, the ACB and Africa CDC are developing a concept note on collaboration between the two institutions, to: ensure health remains a priority on the international agenda; catalyze country-level engagements, leveraging the strategic position of  Regional Economic Communities to foster consensus and support for a unified approach to implementing the Lusaka Agenda shifts; advocate for the interests and perspectives of implementing countries, promoting a more responsive and sustainable approach from GHIs; and empower countries to negotiate more effectively with GHIs.

The ACB is also working with RECs on MOUs setting how regional actors can work together to implement the AU decision once it is published.

The challenges for health financing posed by the economic downturn in Africa and upcoming elections were noted and acknowledged and there was a call to bring together domestic and external financing discussions, with improved coordination between Ministries of Health and Finance and an important role for WHO to help define the pathway to change in Africa.

Two upcoming meetings that provide opportunities to help drive change in Africa were highlighted:

  • The 15-17 April World Bank/USAID/GFF Health Financing Forum in Washington, DC, in the margins of the IMF/World Bank Spring Meetings
  • A 12-13 June WHO-AFRO Technical Consultation on advancing African leadership and unified voice towards realization of the Lusaka Agenda, in Addis Ababa

Roadmap options for the rest of 2024:

Building on the foundations of previous discussions, Working Group members reflected on the areas and forms of collaboration around the Lusaka Agenda that may be beneficial beyond the lifespan of the interim Working Group (i.e. beyond June). Two options were presented for a timeline to identify and establish such arrangements, recognising the need to ensure clarity of objectives, inclusive governance, and funding that matches the ambition of any goals set. Responses from Working Group members recognised the benefits of building in time for adequate analysis and consultation, but also highlighted the need to move as swiftly as possible to maintain momentum and reflect the urgency of the challenge faced. Wellcome will consider these reflections from Working Group members and work with a sub-group of partners to identify a roadmap for moving forward. Membership of this sub-group remains open to all interested partners, who should contact c.battle@wellcome.org to join.

Closing reflections and next steps:

The Co-Chairs closed the meeting noting the consensus to extend the LAWG to end-June and that there may be additional options to be considered for the next phase. They reflected on the encouraging momentum in Africa and suggested that an Africa hub to drive implementation on the continent should be considered. They highlighted their commitment to increase engagement with civil society organizations. Importantly, they called on LAWG members and their Gavi/Global Fund/GFF board members to stay vigilant in driving forward the establishment of the joint working group and the work on pathfinder countries, noting the opportunity of upcoming board retreats and committee meetings.

The Secretariat will revert with a proposed date for next LAWG meeting.